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Z Gastroenterol 2008; 46(1): 45-47
DOI: 10.1055/s-2007-963376
Kasuistik

© Georg Thieme Verlag KG Stuttgart · New York

Postoperative Fulminant Varicella Zoster Virus Hepatitis with Fatal Outcome: a Case Report

Fulminante postoperative Varizella-Zoster Virushepatitis - ein FallberichtU. Drebber1 , S. F. Preuss2 , H. U. Kasper3 , U. Wieland4 , H. P. Dienes1
  • 1Institute of Pathology, University of Cologne, Cologne, Germany
  • 2Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne Germany
  • 3Institute of Pathology, Clemens Hospital, Münster, Germany
  • 4Institute of Virology University of Cologne, Cologne Germany
Further Information

Publication History

manuscript received: 4.3.2007

manuscript accepted: 3.7.2007

Publication Date:
11 January 2008 (online)

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Zusammenfassung

Einleitung: Obwohl effektive Therapien zur Verfügung stehen, hat eine fulminante durch Varizella-Zoster-Virus-(VZV-)Infektion induzierte Hepatitis eine schlechte Prognose. Kasuistik: Wir präsentieren den Fall eines alkoholkranken Patienten mit akutem Leberversagens als Folge einer disseminierten VZV-Infektion. Der Patient hatte sich aufgrund eines Larynxkarzinoms einer Laryngektomie mit radikaler Neck dissection unterzogen. Die Obduktion ergab die Diagnose einer VZV-Infektion mit fulminanter Hepatitis. Virale Einschlusskörper wurden in der Schleimhaut des Hypopharynx und im Lebergewebe nachgewiesen. In diesen Geweben konnte ein Virusnachweis mittels PCR erbracht werden. Der klinische Verlauf deutet in erster Linie auf eine Reaktivierung von VZV unter Immunsuppression hin, auch wenn keine typische dermale Manifestation eines Herpes zoster erkennbar war. Diskussion: Die Differenzialdiagnosen in diesem Fall umfassen Hepatitiden durch andere Mitglieder der Herpes-Virus-Familie und auch einen toxischen Leberparenchymschaden.

Abstract

Introduction: Fulminant hepatitis due to varicella zoster virus (VZV) infection has a poor prognosis although an effective treatment is available. Case Report: We present a case of fulminant hepatic failure (FHF) as a result of disseminated VZV infection in a long-term alcoholic patient who underwent laryngectomy and radical neck dissection due to squamous cell carcinoma of the larynx. Post-mortem examination revealed the diagnosis of fulminant hepatitis and infection with VZV. Viral inclusion bodies were found in the hypopharyngeal mucosa as well as in the liver tissue. In these tissues VZV was detected by PCR. The clinical presentation is suggestive for a reactivation of VZV without cutaneous signs of herpes zoster during a state of immunosuppression. Discussion: Differential diagnosis comprises hepatitis by other Herpes group viruses and toxic hepatic injury.

Schlüsselwörter

Virushepatitis - Varizella-Zoster-Virus - akutes Leberversagen

Key words

viral hepatitis - varicella zoster virus - acute liver failure

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Uta Drebber

Institute of Pathology, University of Cologne

Joseph-Stelzmann-Str. 9

50931 Cologne

Germany

Phone: ++ 49/2 21/4 78 63 70

Fax: ++ 49/2 21/4 78 63 60

Email: u.drebber@uni-koeln.de